Provider Demographics
NPI:1548546468
Name:DEGEORGE, GINA MARIE (PT)
Entity type:Individual
Prefix:
First Name:GINA
Middle Name:MARIE
Last Name:DEGEORGE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:GINA
Other - Middle Name:
Other - Last Name:DEGEORGE-CINA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:1586 QUIET HILLS DR
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92056-2921
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1586 QUIET HILLS DR
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92056-2921
Practice Address - Country:US
Practice Address - Phone:617-306-3270
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-24
Last Update Date:2011-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33906225100000X
MA15660225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist